Shared Savings Model Risk in the MSSP Program
The Centers for Medicare and Medicaid Services (CMS) introduced the Medicare Shared Savings Program (MSSP) for accountable care organizations (ACOs) as part of the Affordable Care Act. Participating ACOs accept risk for the financial outcomes of their assigned populations and share in gains (and, depending on the ACO model, losses) when these are generated. Payers and providers who negotiate value-based contracts need to be aware of and account for model risk in their contracts, particularly as the sizes of populations under management become smaller.
Payment Accuracy in Value-Based Care Contracts
Reimbursement for health care services is transferring more risk away from payers and toward health care providers in the form of Alternative Payment Models (APMs), also known as Value-Based Care (VBC) models. VBC models cover a wide variety of forms but all include guarantees by providers of services to improve quality of care and/or reduce cost.
Comparing Model Error Between a Standard Risk Adjustment Model and a Disease-Specific Risk Adjustment Model
Disease-specific health care interventions and programs are often evaluated with standard risk adjustment models or using more simplistic differences-in-differences approaches that are not customized for the target population. Using models specifically constructed for a target health condition population reduces the magnitude of the model error.
Understanding the impact of five major determinants of health (genetics, biology, behavior, psychology, society/environment) on type 2 diabetes in U.S. Hispanic/Latino families: Mil Familias - a cohort study
A study to determine the influence of the 5 major determinants of human health (genetics, biology, behavior, psychology, society/environment) on the burden of T2D for Latino families
Effects of a Population Health Community-Based Palliative Care Program on Cost and Utilization
An evaluation of utilization and cost outcomes for a community-based palliative care program provided by nurses and social workers.
Impact of Cost on the Safety of Cancer Pharmaceuticals
A chapter, Impact of cost on the safety of cancer pharmaceuticals, by Fitzner and Oteng Mensah in a recent book, Cancer Policy: Pharmaceutical Safety, aims to inform readers about the economics associated with the interplay between safety, costs of cancer treatment, and outcomes of cancer care.
Public Health: Actuaries Weighing in on Healthy People 2030
Healthy People 2030’s vision is a society in which all people achieve their full potential for health and well-being across the life span. The framework outlines foundational principles, a plan of action and goals that are admirable.
Public Health: The New Frontier
The overarching objective of the task force is twofold: first, to educate actuaries on the importance of public health and how it can inform and affect our work as actuaries—we call this the “inward” focus; and second, to open channels to enable actuaries to contribute to public health efforts—we call this the “outward” focus.
The Choices People Make (and Their Implications for Private Exchanges)
Choice overload - the concept that individuals struggle to make a good decision, or even any decision, when presented with too much choice - is a well-researched phenomenon in behavioral economics, and we would expect to see this in health plan decisions.
Medication Days' Supply, Adherence, Wastage, and Cost Among Chronic Patients in Medicaid
A study conducted to determine whether 90- day refills at community pharmacies could improve adherence, minimize wastage, and control costs
Mining Health Claims Data for Assessing Patient Risk
From the book, Data Mining: Foundations and Intelligent Paradigms, comes a chapter on applying data mining techniques to quantify patient risk
A Comparative Analysis Of Chronic And Nonchronic Insured Commercial Member Cost Trends
Chronic and nonchronic cost trends between 1999 and 2002 published by The North American Actuarial Journal